Table 3.
Studies comparing the effects of different techniques within a given type of anesthesia on POCD
| Study | Year | Study group | Age (years)* | Anesthetic type | Group 1 | Group 2 | Variables evaluated | Assessment time | Difference found? | Findings | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Intervention/ characteristic | Number of patients | Intervention/ characteristic | Number of patients | |||||||||
| Prospective randomized blinded studies | ||||||||||||
| Ballard et al. [4] | 2012 | Noncardiac major surgery | 75 (72–81) | GA | EEG and regional brain oxygenation monitoring | 34 | Typical protocol, no advanced monitoring | 38 | MMSE CAM Neuropsychologic tests | Preop 1 week 12 weeks 52 weeks | Yes | Decreased mild cognitive decline at all time points (p = 0.018 at 1 week, p = 0.02 at 12 weeks, p = 0.015 at 52 weeks) |
| Leung et al. [29] | 2006 | Noncardiac major surgery | 74 (65–95) | GA | N2O and O2 maintenance | 105 | O2 maintenance | 105 | CAM neuropsychologic tests | POD 1, 2 | No | No difference in delirium (41.9% vs 43.8%) or cognitive decline (14.8% vs 18.6%) |
| Wong et al. [47] | 2002 | TKA, THA | 71 (NR) | GA | EEG monitoring | 29 | Typical protocol, no advanced monitoring | 31 | MMSE Neuropsychologic tests Clinical confusion | 30, 60, 120 minutes 24,48,72 hours | No | No difference in neuropsychological tests (p values not reported) |
| Fernandez-Galinski et al. [12] | 2005 | TKA, THA | 75 (70–88) | Spinal | 4 mg bupivicaine 15 μg fentanyl 15 μg clonidine | 31 | 6.25 mg bupivicaine 25 μg fentanyl | 30 | MMSE | On arrival to recovery room | No | No difference in MMSE change between groups (p = 0.957) |
| Prospective randomized studies | ||||||||||||
| Rasmussen et al. [39] | 2006 | TKA | 71 (NR) | Spinal | 65% xenon | 20 | Propofol infusion | 16 | ISPOCD cognitive tests | Preop At discharge 10–14 weeks | No | Similar incidence of cognitive decline at discharge (p = 0.88) and 3-month followup (p = 0.77) |
| Case-control studies | ||||||||||||
| Steinmetz et al. [44] | 2010 | Noncardiac major surgery | 68 (61–83) | GA with EEG monitoring | POCD positive | 9 | POCD negative | 56 | Neuropsychologic tests | Preop 1 week | No | No difference in depth of anesthesia (time spent at different depths) between patients who did and did not develop POCD (specific values not reported) |
* Values are expressed as mean, with range in parentheses; POCD = postoperative cognitive dysfunction; NR = not reported; GA = general anesthesia; N2O = nitrous oxide; O2 = oxygen; CAM = Confusion Assessment Method; MMSE = Mini Mental Status Examination; ISPOCD = International Study on Postoperative Cognitive Dysfunction; preop = preoperatively.